Abstract
Degenerative disk disease (DDD) is a common cause of low back pain (LBP); however, the exact relationship between the two remains unknown. The functional spinal unit (FSU) consisting of an anterior intervertebral disk and two posterior facet joints undergo structural changes as a result of degeneration, which may lead to LBP. Over time we have come to understand that the pathophysiology of DDD is most likely a multifactorial process. Degeneration of the spine is an inevitable consequence of aging and can be due to repetitive biomechanical loading of the spine and genetic predisposition. Clinical presentation is a key to the diagnosis of DDD with the physical exam being an important adjunct in determining discogenic etiology of symptoms. Other disorders may elicit LBP and should be considered during the history and physical examination. Magnetic resonance imaging (MRI) is the gold standard diagnostic tool for the evaluation of DDD. Conservative management is reasonable as majority of these patients recover from their symptoms. The most common surgical interventions involve fusion and more recently artificial total disk replacement (TDR). In addition, each procedure and surgical approach has advantages and disadvantages with associated complications.
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References
Anderson JA (1986) Epidemiological aspects of back pain. J Soc Occup Med 36(3):90–94
Aprill C, Bogduk N (1992) High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging. Br J Radiol 65(773):361–369
Battie MC, Videman T, Parent E (2004) Lumbar disc degeneration: epidemiology and genetic influences. Spine 29(23):2679–2690
Bijkerk C, Houwing-Duistermaat JJ, Valkenburg HA, Meulenbelt I, Hofman A, Breedveld FC, Pols HA, van Duijn CM, Slagboom PE (1999) Heritabilities of radiologic osteoarthritis in peripheral joints and of disc degeneration of the spine. Arthritis Rheum 42(8):1729–1735
Buckwalter JA (1995) Aging and degeneration of the human intervertebral disc. Spine 20(11):1307–1314
Butler D, Trafimow JH, Andersson GB, McNeill TW, Huckman MS (1990) Discs degenerate before facets. Spine 15(2):111–113
Button G, Gupta M, Barrett C, Cammack P, Benson D (2005) Three- to six-year follow-up of stand-alone BAK cages implanted by a single surgeon. Spine J 5(2):155–160
Chen CS, Cheng CK, Liu CL (2002) A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine. J Spinal Disord Tech 15(1):53–63
Cinotti G, Della Rocca C, Romeo S, Vittur F, Toffanin R, Trasimeni G (2005) Degenerative changes of porcine intervertebral disc induced by vertebral endplate injuries. Spine 30(2):174–180
Cohen SP, Larkin TM, Barna SA, Palmer WE, Hecht AC, Stojanovic MP (2005) Lumbar discography: a comprehensive review of outcome studies, diagnostic accuracy, and principles. Reg Anesth Pain Med 30(2):163–183
Coppes MH, Marani E, Thomeer RT, Groen GJ (1997) Innervation of “painful” lumbar discs. Spine 22(20):2342–2349; discussion 2349–2350
Friberg S, Hirsch C (1949) Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop Scand 19(2):222–242, illust
Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA (2001) Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 26(5):567–571
Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J (1978) Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3(4):319–328
Lotz JC, Hsieh AH, Walsh AL, Palmer EI, Chin JR (2002) Mechanobiology of the intervertebral disc. Biochem Soc Trans 30(Pt 6):853–858
Matsui H, Kanamori M, Ishihara H, Yudoh K, Naruse Y, Tsuji H (1998) Familial predisposition for lumbar degenerative disc disease. A case–control study. Spine 23(9):1029–1034
Miller JA, Schmatz C, Schultz AB (1988) Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine 13(2):173–178
Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A (1994) Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine 19(12):1371–1380
Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H (1996) Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine 21(8):917–924
Nakamura SI, Takahashi K, Takahashi Y, Yamagata M, Moriya H (1996) The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration. J Bone Joint Surg Br 78(4):606–612
Niosi CA, Oxland TR (2004) Degenerative mechanics of the lumbar spine. Spine J 4(6 Suppl):202S–208S
Roughley PJ, Alini M, Antoniou J (2002) The role of proteoglycans in aging, degeneration and repair of the intervertebral disc. Biochem Soc Trans 30(Pt 6):869–874
Sambrook PN, MacGregor AJ, Spector TD (1999) Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 42(2):366–372
Schultz A, Andersson G, Ortengren R, Haderspeck K, Nachemson A (1982) Loads on the lumbar spine. Validation of a biomechanical analysis by measurements of intradiscal pressures and myoelectric signals. J Bone Joint Surg Am 64(5):713–720
Vanharanta H, Sachs BL, Spivey MA, Guyer RD, Hochschuler SH, Rashbaum RF, Johnson RG, Ohnmeiss D, Mooney V (1987) The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography. Spine 12(3):295–298
Walsh TR, Weinstein JN, Spratt KF, Lehmann TR, Aprill C, Sayre H (1990) Lumbar discography in normal subjects. A controlled, prospective study. J Bone Joint Surg Am 72(7):1081–1088
Weber H (1994) The natural history of disc herniation and the influence of intervention. Spine 19(19):2234–2238; discussion 2233
Weinstein J, Claverie W, Gibson S (1988) The pain of discography. Spine 13(12):1344–1348
Yang KH, King AI (1984) Mechanism of facet load transmission as a hypothesis for low-back pain. Spine 9(6):557–565
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Singh, K., Hoskins, J.A., Fineberg, S.J., Oglesby, M. (2014). Degenerative Disk Disease with and Without Facet Arthritis. In: Patel, V., Patel, A., Harrop, J., Burger, E. (eds) Spine Surgery Basics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34126-7_19
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DOI: https://doi.org/10.1007/978-3-642-34126-7_19
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